Healthcare Provider Details

I. General information

NPI: 1124770847
Provider Name (Legal Business Name): FALCO MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S WHISMAN RD
MOUNTAIN VIEW CA
94041-1512
US

IV. Provider business mailing address

160 S WHISMAN RD
MOUNTAIN VIEW CA
94041-1512
US

V. Phone/Fax

Practice location:
  • Phone: 415-853-9979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONAH MINK
Title or Position: PRESIDENT
Credential: MD
Phone: 415-853-9979